{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T01:37:23Z","timestamp":1792201043699,"version":"4.4.0"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,4,5]],"date-time":"2017-04-05T00:00:00Z","timestamp":1491350400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>Petrous apicitis (PA) is a rare complication of otitis media. Gradenigo syndrome, with the classic triad of otitis, deep pain, and abducens paralysis, is rarer still. The objective of this study was to determine if clinical presentation and management has changed over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective chart review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Forty\u2010four patients with PA over a 40\u2010year period were studied. Symptoms, signs, and management outcomes were studied. Historical review, surgical anatomy and approaches, pathology, and microbiology, and an illustrative case are included as appendices.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The classical Gradenigo triad of retro\u2010orbital pain, otitis, and abducens palsy occurred in only six of 44 patients (13.6%). Over the 40\u2010year observation period, those needing surgery has decreased.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Antibiotics remain the primary treatment modality. Surgery is reserved for cases failing to respond to antibiotics. One of the 44 patients in this series died of his disease. Diagnosis and management algorithms based on these observations are suggested.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4. <jats:italic>Laryngoscope<\/jats:italic>, 128:195\u2013201, 2018<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.26571","type":"journal-article","created":{"date-parts":[[2017,4,5]],"date-time":"2017-04-05T18:45:01Z","timestamp":1491417901000},"page":"195-201","source":"Crossref","is-referenced-by-count":63,"title":["The changing face of petrous apicitis\u2014a 40\u2010year experience"],"prefix":"10.1002","volume":"128","author":[{"given":"Arun K.","family":"Gadre","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Heuser Hearing Institute, University of Louisville Louisville Kentucky U.S.A."},{"name":"Department of Surgery Heuser Hearing Institute, University of Louisville Louisville Kentucky U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A.","family":"Chole","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Washington University St. Louis Missouri U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,4,5]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-195806000-00005"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-5998(98)70100-7"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348948309200603"},{"key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1001\/archotol.1937.00650020048006","article-title":"Suppuration of the petrous pyramid some views on its surgical management","volume":"26","author":"Myerson MC","year":"1937","journal-title":"Arch Otolaryngol"},{"key":"e_1_2_9_6_1","first-page":"60","article-title":"Ueber Circumscripte Leptomeningitis mit spinalen Symptomen","volume":"51","author":"Gradenigo G","year":"1904","journal-title":"Arch Ohrenheilk"},{"key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/BF01930369","article-title":"Uber die Paralyse des Nervus abducens bei Otitis Gradenigo, G","volume":"774","author":"Gradenigo G","year":"1907","journal-title":"Arch Ohrenheilkunde"},{"key":"e_1_2_9_8_1","first-page":"51","article-title":"Discussion","volume":"3","author":"Panse R","year":"1905","journal-title":"Int Centralbl Ohrenheilk"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016483209127994"},{"key":"e_1_2_9_10_1","first-page":"319","article-title":"Zur Kenntnis der Entstehung der otogenen Meningitis","volume":"18","author":"Haymann L","year":"1927","journal-title":"Zeitschr HNO"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1931.04230020033003"},{"key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1007\/BF01606960","article-title":"Eine zu vielfachen Verwickelungen fuhrende, sehrausgedehnte perilabyrinthare Eiterung im histologischen Bilde","volume":"122","author":"Uffenorde W","year":"1929","journal-title":"Arch Ohren Nasen Kehlkopfh"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1931.04230020072005"},{"key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1001\/archotol.1931.03660010097011","article-title":"Gradenigo's Syndrome anatomic aspects","volume":"13","author":"Meltzer PE","year":"1931","journal-title":"Arch Otolaryngol"},{"key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"97","DOI":"10.3109\/00016483209127994","article-title":"Ref. 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